At BSSNY, our expert physicians and surgeons offer a broad range of life-changing neurological care to help patients get their lives back – all in the comfort and convenience of a private practice just minutes away from where you live and work.
An acoustic neuroma – also called a vestibular schwannoma – is a benign tumor that presses on the “acoustic nerve.” Signs of acoustic neuroma include a gradual or rapid loss of hearing in one ear, and tinnitus or ringing in the ear. Another sign can be dizziness or balance difficulty because the acoustic nerve affects balance. If the tumor is large it may cause facial numbness or weakness. This kind of tumor can cause permanent hearing loss.
Treatment options for acoustic neuromas include observation, radiation, or surgery. Since typically it is a slow-growth tumor, it may be treated using Gamma Knife technology, a non-invasive procedure that focuses radiation directly on the tumor to halt its growth. Another option is to remove part of the tumor using minimally invasive surgery. However, when it is necessary to totally remove the lesion, traditional surgery is recommended.
A cerebral aneurysm – also known as an intracranial aneurysm – is a bulge or ballooning of an arterial blood vessel in the brain. If an intracranial aneurysm ruptures, it can result in stroke, brain damage, or even death. Therefore, it is important to seek immediate treatment if you experience an unusually severe headache. Other signs of a ruptured cerebral aneurysm may be nausea, a stiff neck and sensitivity to light.
Prior to rupture, cerebral aneurysms are generally difficult to detect because most are asymptomatic. We treat cerebral aneurysms three different ways:
Endovascular embolization – or coiling – halts the flow of blood into the aneurysm by sealing it off. A relatively new and minimally invasive procedure, it has become the treatment of choice. A catheter is inserted into an artery in the patient’s leg and guided to the aneurysm. Tiny platinum coils are threaded through the catheter and released to fill the entire aneurysm so blood flow into it is stopped.
Clipping is a common surgical treatment. A craniotomy is performed to open the section of the skull so that the surgeons can access the aneurysm beneath. A tiny metal clip is attached to the base of the aneurysm so blood flows past it. This helps prevent possible rupture or re-rupture.
Occlusion and Bypass shut down the damaged artery and redirects the blood around the occluded artery. A craniotomy is performed to open the section of the skull so that the surgeons can access the aneurysm beneath. If necessary, a blood vessel is taken from another part of the body and grafted to the artery to bypass the occlusion.
For more information, visit The Brain Aneurysm Foundation.
An arteriovenous malformation (AVM) is a rare defect of the circulatory system that develops either before birth or soon after. Blood flows from an artery directly into a vein through a passage known as a fistula, depriving the surrounding tissue of oxygen. Although AVM can occur anywhere in the body, it can have serious consequences when it occurs in the brain or spinal cord, where it can reduce the amount of oxygen delivered to the brain, press on nerves, or cause hemorrhaging.
The most common symptom of an AVM is headaches. Other symptoms include:
Only about 12 percent of people with AVMs even have symptoms. Symptoms are most often noticed in a person’s twenties, thirties or forties.
Not all AVMs need treatment or can be treated. Neurosurgeons may use conventional surgery to remove the fistula. If possible, a less invasive approach using endovascular embolism will be used to plug the fistula using fast-drying biologically inert glues, fibered titanium coils, and tiny balloons. Lastly, radiosurgery will direct a high dose of radiation to damage the blood vessels in the fistula, which will degenerate and close off the lesion.
Cavernous malformations – also called cavernomas – are a specific type of AVM made of clusters of tiny abnormal blood vessels, and larger, stretched-out, thin-walled blood vessels filled with blood in the brain. Not all cavernous malformations need treatment, but all require regular monitoring.
Symptoms depend on the hemorrhage and its location in the brain. A patient may experience seizures, headaches, memory and attention problems, weakness in arms or legs, vision problems, and balance problems. However, many people with cavernomas are asymptomatic and the lesions are discovered by chance.
Symptomatic cavernomas can be treated through medication alone. Surgery is recommended if a patient experiences one neurologically symptomatic hemorrhage from a lesion in an easily accessible area of the brain, where there is a low risk of interference with neurological function.
Brain tumors are divided into many classifications. Primary brain tumors refer to tumors that originate in the brain, and metastatic tumors are tumors that originate elsewhere in the body and travel through the bloodstream to the brain. Primary brain tumors may be either benign or malignant. Metastatic tumors are malignant.
Most tumors are biopsied prior to treatment. In cases where the tumor is adjacent to vital structures, a decision may be made prior to surgery to perform only a biopsy rather than attempting to remove the entire tumor.
Some brain tumors do not produce symptoms. Other times, symptoms may include headaches (especially at night), seizures or neurological difficulties related to speech, vision, numbness, weakness, balance, or walking.
The total treatment of brain tumors is a team effort. This involves the neurosurgeon, the medical oncologist, the radiation oncologist, their staffs and the patient and family. New treatments are being developed rapidly and the prognosis for patients with brain tumors is brighter than it ever was in the past.
For additional information about brain tumors and their treatment, visit the American Brain Tumor Association at www.abta.org, the National Brain Tumor Foundation at www.braintumor.org or the Acoustic Neuroma Association.
Plaque buildup in a carotid artery – the main blood vessels to the brain – can lead to stroke or a transient ischemic attack (TIA), also known as a “mini-stroke.” Severe blockage is called carotid stenosis. If blood flow is severely restricted, one may experience stroke-like symptoms, such as vision loss and difficulty speaking. However, many individuals with carotid stenosis may not experience any symptoms.
Depending on the degree of stenosis and the patient’s overall condition, carotid artery stenosis can usually be treated with surgery. We perform a procedure called carotid endarterectomy to remove plaque, which has proven to benefit patients with arteries narrowed by 70 percent or more. For people with arteries narrowed less than 50 percent, we typically prescribe antiplatelet agents or anticoagulants medication to reduce the risk of ischemic stroke. In all instances, we recommend a better diet, more exercise, and a refrain from tobacco use.
Carotid angioplasty — in which a balloon or stent is inserted to open the narrowed artery — may be another non-surgical treatment option.
For more information, visit the American Heart Association.
This disorder refers to a set of anomalies of the base of the skull and cervical spine. It occurs when the brainstem and cerebellum are forced to protrude down into the spinal canal through the hole at the base of the skull. Symptoms can vary from irritating to disabling, and may include pain in the arm, decreased sensation in the arms or hands, difficulty in walking, headache and neck pain, swallowing difficulties and/or hoarseness.
Although what causes Chiari malformations is unknown, it may be a result of trauma to the skull or may simply be present at birth. Surgery is recommended to decompress the area and relieve pressure on the cerebellum. This can be accomplished by removing a small portion of the skull to provide extra room for the brainstem and cerebellum, or insertion of a shunt to drain accumulations of spinal fluid within the spinal cord.
In patients with epilepsy, the brain’s normal electrical pattern is disrupted by sudden bursts of electrical energy that can cause loss of consciousness and seizures. Brain surgery may be an option if seizures cannot be controlled through medication or other non-invasive treatment. It is particularly effective when seizures appear to be caused by abnormalities such as benign brain tumors, cortical dysplasia, arteriovenous malformations, cavernous angiomas, tuberous sclerosis, and strokes. The surgery confirms whether there is an association and then the condition is treated.
Surgery also may involve cutting the nerve fibers, or corpus callosum, that connect the two hemispheres of the brain. That limits any burst of electrical impulses from one side of the brain to the other. Vagus nerve stimulation (VNS) helps control seizures through the implant of a small stimulator that sends regular mild pulses of electrical energy to the brain via the vagus nerve.
If you experience any hard blow to the head, you should seek emergency treatment immediately, even if there are no immediate symptoms. The same holds true if the blow is not hard but produces bleeding, loss of consciousness, severe headache, repeated vomiting, confusion, loss of balance, weakness in an arm or leg, unequal pupil size, slurred speech or seizure. You may have sustained a traumatic brain injury (TBI), which is defined as a blow to the head or a penetrating head injury that disrupts the normal function of the brain. In severe cases, one may experience unconsciousness, coma, or even death.
Emergency surgery is called for if neurosurgeons find a hematoma (a blood clot) within the brain or on its surface, or a cerebral contusion (bruising of brain tissue), compressing the brain or increasing pressure within the skill. A blood clot in the brain itself may be removed through surgery if it puts too much pressure on the brain. Since contusions or hematomas may enlarge over the first hours or days after the incident, the injury should be closely monitored and surgery performed at that time.
A traumatic head injury may result in a subarachnoid hemorrhage (SAH), epidural hemorrhage (EDH), or intracerebral hemorrhage (ICH). The size and location of the hemorrhage help determine whether it can be removed surgically.
TBI also can result in hydrocephalus or a condition in which excess cerebrospinal fluid builds up in the brain, causing increased pressure within the head. The pressure is relieved through surgical placement of a shunt to direct the fluid where it will not pressure brain tissue.
For more information, visit the National Institute of Neurological Disorders and Stroke.
Hydrocephalus is a condition caused by excessive accumulation of fluid in the brain.
Once known as “water on the brain,” the fluid actually is cerebrospinal fluid, a clear fluid surrounding the brain and spinal cord. An excessive accumulation causes potentially harmful pressure on the tissues of the brain. Hydrocephalus can be present at birth or caused by traumatic injury or diseases such as meningitis and cancer. Symptoms in infants include an unusually large head size, vomiting, sleepiness, and seizures. Older children and adults may experience headaches, vomiting, nausea, vision problems, balance and coordination disturbances, urinary incontinence, and personality or cognitive changes. An MRI may help diagnose the condition. Hydrocephalus can be treated with the surgical placement of a shunt system, which diverts the flow of fluid to another part of the body where it can be absorbed as part of the normal circulatory process.
Parkinson’s disease is a progressive disorder that affects movement and coordination. It occurs when nerve cells that produce dopamine — which works with other neurotransmitters to coordinate movement — become impaired. The most common symptoms are trembling in the hands, arms, legs, and jaw; rigidity or stiffness of the limbs; slowness of movement; and impaired balance and coordination.
The primary treatment of Parkinson’s is the use of medication to control symptoms. As the disease progresses, surgery may be considered to relieve the involuntary movements. By operating on the deep brain structures involved in motion control — the thalamus, globus pallidus and subthalamic nucleus — a neurosurgeon may help relieve Parkinson’s symptoms.
There are three basic types of surgery:
Pallidotomy is performed by inserting a wire probe into the globus pallidus, which is thought to become hyperactive in Parkinson’s patients due to the loss of dopamine. This can help restore the balance that normal movement requires.
Thalamotomy uses radiofrequency energy currents to destroy a small, but specific portion of the thalamus. This may benefit patients with disabling tremors in the hand or arm, but it does not relieve other.
The Deep Brain Stimulation (DBS) offers a safer alternative to pallidotomy and thalamotomy. It uses small electrodes that are implanted to provide an electrical impulse to either the subthalamic nucleus of the thalamus or the globus pallidus. Implantation of the electrode is guided through magnetic resonance imaging (MRI) and neurophysiological mapping, to pinpoint the correct location. The electrode is connected to wires that lead to an impulse generator or IPG (similar to a pacemaker) that is placed under the collarbone and beneath the skin. Patients have a controller, which allows them to turn the device on or off. The electrodes are usually placed on one side of the brain. An electrode implanted in the left side of the brain will control the symptoms on the right side of the body and vice versa. Some patients may need to have stimulators implanted on both sides of the brain.
This form of stimulation helps rebalance the control messages in the brain, thereby suppressing tremor. DBS of the subthalamic nucleus or globus pallidus may be effective in treating all of the primary motor features of Parkinson’s, and may allow for significant decreases in medication doses.
For more information, visit the National Parkinson Foundation.
Tourette Syndrome is an abnormality of the central nervous system that produces involuntary and repetitive motor and vocal tics. Many tics may be controlled by medication. However, in the case of severe disabling tics that cannot be contained via medication, the patient may benefit from deep brain stimulation (DBS) surgical treatment. Commonly used to treat epilepsy and Parkinson’s disease, DBS has been used to successfully relieve Tourette’s symptoms.
DBS surgical treatment of Tourette’s is offered by a limited number of neurosurgeons, including Brain & Spine Surgeons of New York.
Trigeminal neuralgia (also known as Tic douloureux) is a condition of excruciating facial pain. Often the pain can be triggered by activities such as touching your mouth, talking, eating, brushing your teeth, shaving, a cold wind or even a light breeze. These pains often last only moments, but the pain is so severe as to be incapacitating. It is caused by vascular compression of the fifth cranial (trigeminal) nerve. It may involve one, two or (rarely) three branches of the nerve. It rarely occurs on both sides of the face.
If medication is not effective or side effects of the medications are unacceptable, surgical treatment may be considered. The surgical approaches include blocking the appropriate nerve or microvascular decompression, in which sponge-like material is placed between the trigeminal nerve and adjacent blood vessels to alleviate pressure from blood flow.
For more information, visit the Facial Pain Association website.